Susana Cristina Rodrigues

Abstract
How we perceive and experience the world around us is inherently multisensory. Most of the Virtual Reality (VR) literature is based on the senses of sight and hearing. However, there is a lot of potential for integrating additional stimuli into Virtual Environments (VEs), especially in a training context. Identifying the relevant stimuli for obtaining a virtual experience that is perceptually equivalent to a real experience will lead users to behave the same across environments, which adds substantial value for several training areas, such as firefighters. In this article, we present an experiment aiming to assess the impact of different sensory stimuli on stress, fatigue, cybersickness, Presence and knowledge transfer of users during a firefighter training VE. The results suggested that the stimulus that significantly impacted the user's response was wearing a firefighter's uniform and combining all sensory stimuli under study: heat, weight, uniform, and mask. The results also showed that the VE did not induce cybersickness and that it was successful in the task of transferring knowledge.

Abstract
The advantages of Virtual Reality (VR) over traditional training, together with the development of VR technology, have contributed to an increase in the body of literature on training professionals with VR. However, there is a gap in the literature concerning the comparison of training in a Virtual Environment (VE) with the same training in a Real Environment (RE), which would contribute to a better understanding of the capabilities of VR in training. This paper presents a study with firefighters (N = 12) where the effect of a firefighter training exercise in a VE was evaluated and compared to that of the same exercise in a RE. The effect of environments was evaluated using psychophysiological measures by evaluating the perception of stress and fatigue, transfer of knowledge, sense of presence, cybersickness, and the actual stress measured through participants' Heart Rate Variability (HRV). The results showed a similar perception of stress and fatigue between the two environments; a positive, although not significant, effect of the VE on the transfer of knowledge; the display of moderately high presence values in the VE; the ability of the VE not to cause symptoms of cybersickness; and finally, obtaining signs of stress in participants' HRV in the RE and, to a lesser extent, signs of stress in the VE. Although the effect of the VE was shown to be non-comparable to that of the RE, the authors consider the results encouraging and discuss some key factors that should be addressed in the future to improve the results of the training VE.

Abstract
The use of Virtual Reality (VR) technology to train professionals has increased over the years due to its advantages over traditional training. This paper presents a study comparing the effectiveness of a Virtual Environment (VE) and a Real Environment (RE) designed to train firefighters. To measure the effectiveness of the environments, a new method based on participants' Heart Rate Variability (HRV) was used. This method was complemented with self-reports, in the form of questionnaires, of fatigue, stress, sense of presence, and cybersickness. An additional questionnaire was used to measure and compare knowledge transfer enabled by the environments. The results from HRV analysis indicated that participants were under physiological stress in both environments, albeit with less intensity on the VE. Regarding reported fatigue and stress, the results showed that none of the environments increased such variables. The results of knowledge transfer showed that the VE obtained a significant increase while the RE obtained a positive but non-significant increase (median values, VE: before - 4 after - 7, p = .003; RE: before - 4 after - 5, p = .375). Lastly, the results of presence and cybersickness suggested that participants experienced high overall presence and no cybersickness. Considering all results, the authors conclude that the VE provided effective training but that its effectiveness was lower than that of the RE.

Abstract
Objective: Heart rate variability (HRV), an index of the autonomic cardiac activity, is decreased in patients with epilepsy, and a low HRV is associated with a higher risk of sudden death. Generalized tonic-clonic seizures are one of the most consistent risk factors for SUDEP, but the influence (and relative risk) of each type of seizure on cardiac function is still unknown. Our objective was to assess the impact of the type of seizure (focal to bilateral tonic-clonic seizure - FBTCS - versus non-FBTCS) on periictal HRV, in a group of patients with refractory epilepsy and both types of seizures. Methods: We performed a 48-hour Holter recording on 121 patients consecutively admitted to our Epilepsy Monitoring Unit. We only included patients with both FBTCS and non-FBTCS on the Holter recording and selected the first seizure of each type to analyze. To evaluate HRV parameters (AVNN, SDNN, RMSSD, pNN20, LF, HF, and LF/HF), we chose 5-min epochs pre-and postictally. Results: We included 14 patients, with a median age of 36 (min-max, 16-55) years and 64% were female. Thirty-six percent had cardiovascular risk factors, but no previously known cardiac disease. In the preictal period, there were no statistically significant differences in HRV parameters, between FBTCS and non-FBTCS. In the postictal period, AVNN, RMSSD, pNN20, LF, and HF were significantly lower, and LF/HF and HR were significantly higher in FBTCS. From preictal to postictal periods, FBTCS elicited a statistically significant rise in HR and LF/HF, and a statistically significant fall in AVNN, RMSSD, pNN20, and HF. Non-FBTCS only caused statistically significant changes in HR (decrease) and AVNN (increase). Significance/conclusion: This work emphasizes the greater effect of FBTCS in autonomic cardiac function in patients with refractory epilepsy, compared to other types of seizures, with a significant reduction in vagal tonus, which may be associated with an increased risk of SUDEP.

Abstract
The main goal of this systematic review is to synthesize existing evidence on the use of immersive virtual reality (IVR) to train professionals as well as to identify the main gaps and challenges that still remain and need to be addressed by future research. Following a comprehensive search, 66 documents were identified, assessed for relevance, and analysed. The main areas of application of IVR-based training were identified. Moreover, we identified the stimuli provided, the hardware used and information regarding training evaluation. The results showed that the areas in which a greater number of works were published were those related to healthcare and elementary occupations. In hardware, the most commonly used equipment was head mounted displays (HMDs), headphones included in the HMDs and handheld controllers. Moreover, the results indicated that IVR training systems are often evaluated manually, the most common metric being questionnaires applied before and after the experiment, and that IVR training systems have a positive effect in training professionals. We conclude that the literature is insufficient for determining the effect of IVR in the training of professionals. Although some works indicated promising results, there are still relevant themes that must be explored and limitations to overcome before virtual training replaces real-world training.